High grade dysplastic rectal adenoma in a young patient with Café-au-lait spots: A case reportAli Hamdan1, Razan Abou Zeid2, Jana Khalil3, Karam Karam4, Elias Fiani5*Medical Doctor, Department of Internal Medicine, University of Balamand, Beirut, Lebanon. Email: ali.hamdan.dr@outlook.comMedical student, University of Balamand, Beirut, Lebanon. Email: razan.abouzeid@std.balamand.edu.lbMedical student, University of Balamand, Beirut, Lebanon. Email: jana.khalil@std.balamand.edu.lbMedical doctor, Department of Gastroenterology, University of Balamand, Beirut, Lebanon. Email: Karamek7@gmail.comAssociate Professor, Department of Gastroenterology, University of Balamand, Beirut, Lebanon. Email: Elias.fiani@hotmail.com *CORRESPONDING AUTHORKey Clinical Message: Colorectal cancer screening guidelines typically focus on familial history and age-related risk factors, yet Café-au-lait macules could serve as early indicators for tailored surveillance protocols. This case underscores the importance of considering extracolonic manifestations in young patients presenting with colorectal symptoms. We present a case of a young patient with café-au-lait spots who was diagnosed with rectal tubulo-villous dysplastic adenoma following rectal bleeding.Keywords: Café-au-lait macules; Café-au-lait spots; Tubulo-villous dysplastic adenoma; Extracolonic manifestations; Case report.